Do-It-Yourself Brain Zapping

An unfriendly nurse orders the gown-clothed patient to climb onto the gurney.  Beside the gurney on a table stands an ominous-looking black box with dials and switches, and a cable running from it to a two-armed thing that looks like the doctor's end of a stethoscope.  Only instead of earplugs, it's got two cloth-covered steel electrodes.  The patient lies on the table and two other nurses stand next to her, ready to hold her down.  You see a closeup of a jar of greasy stuff that the head nurse applies to the patient's temples.  Then the scene cuts to the black box as the nurse throws the switch.

The film "The Snake Pit" (1948) stars Olivia DeHavilland as Virginia Cunningham, a patient in a mental hospital, and was based on memoirs by a former mental patient.  The black box, of course, is an electroconvulsive therapy (ECT) machine, which was one of the few effective treatments known in 1948 for severe depression.  A current passes through the brain that is large enough to induce an epileptic seizure, and in enough cases to be useful, the resulting massive reorganizing of neural behavior can improve the patient's condition.  But the treatment has frequent and serious side effects, including confusion and memory loss.

Somehow I don't think too many people who currently practice a much milder version of the same thing—transcranial direct current stimulation, or tDCS—have seen "The Snake Pit."  The process of tDCS consists of sending no more than a couple of milliamperes of current through one's head with electrodes that can be placed in different areas, depending on what you want to do to your brain.  The simplicity of the equipment (the whole thing can run on a nine-volt battery) and the expense of conventional medical treatment for conditions such as depression, anxiety, or ADHD (attention-deficit hyperactivity disorder) has created a small but active cadre of do-it-yourself tDCS users.  And a market for commercially made devices has come about to serve them as well.  

In a recent New York Times article, Anna Wexler, a Ph. D. student at MIT, noted that the medical journal Annals of Neurology published an open letter addressed to tDCS "amateurs," as you might call them.  Somewhat surprisingly, the medical folks didn't come out with guns blazing and condemn all non-professionally-authorized use.  Instead, they rather mildly warned about some of the known hazards (mainly skin irritation) and said that the effects of tDCS can be long-lasting and unpredictable. 

I have a confession to make.  One day in my garage lab back when I was in high school, I made a pulse circuit that put out about 10 volts, and out of curiosity more than anything else, I took the two wires coming out of the circuit and touched them to my sweaty temples (the room wasn't air conditioned and this was summertime in Fort Worth, Texas).  I was rewarded with what is called a "phosphene" flashing in time with the pulses.  A phosphene is a kind of visual hallucination arising from direct stimulation of nerves associated with vision.  After that, I decided I liked my brain the way it was, and didn't fool with tDCS anymore.  But I can vouch for the simplicity of the equipment, at any rate. 

In her editorial, Wexler praises the doctors for extending an olive branch, as it were, to the do-it-yourselfers, at least those who happen to read Annals of Neurology.  Somehow I don't expect that's too many people.  But speaking more generally, there is a moral issue here about the high cost of medical care and the things people will do who simply can't afford conventional treatments. 

People who are ill are by definition vulnerable, and deserve to be treated with respect, in both senses of the word:  treated medically, and treated as a fellow human being in need.  Before the age of modern scientific medicine, everyone was pretty much in the same leaky boat medically.  Hardly any medical treatments did any good, and so even the rich folks who could afford expensive so-called doctors didn't get much in the way of real help from the medical profession.  But with the huge advances that scientific medicine has made in the last century, we can now defeat entire diseases such as smallpox and do a great deal to prevent or alleviate others.  All these advances come at a price, however.  And the big question now is, who pays the price?

There are two extremes in the approach to funding medical care, and most countries fall somewhere in between the two extremes.  At one extreme is the on-your-own approach.  Countries that are too dysfunctional to have anything resembling a government fall into this category.  If you have enough money and can afford to travel and pay for medical care, you get it.  Otherwise, you're out of luck.  At the other extreme is the single-payer government-does-it-all approach.  I am told that Cuba does something along these lines.  Maybe a few people have made a trip to Cuba just for the medical care, but not many.  Less extreme and more functional is the government-run medical system in Canada, which treats medical care as simply something that every Canadian has a right to.  In the nature of things, this leads to some sort of rationing.  Even if Canadians had a lot of gripes about their system, they are probably too polite to air them in public so that we in the U. S. can hear. 

And then there is our crazy patchwork of Federal, state, local, private, and charity-provided medical care here in the U. S., augmented  since 2010 by the Affordable Care Act.  I have seen some reports that some of the "exchanges" set up by ACA are in deep financial trouble.  But believing that our present Congress will pull itself together long enough to make sensible improvements to that legislation takes an act of imagination that I am presently incapable of—without tDCS, anyway. 

If anybody reading this blog gets the idea to try tDCS, please don't do it on my account.  My brief encounter with it all those years ago made me decide to leave it alone, and I don't want to be responsible for any negative consequences arising from reading an ethics blog.  On the other hand, if anyone reading this has used tDCS and think it works, it would be interesting to hear from you.  Bearing in mind, of course, that it affects everybody differently, so if someone writes in saying their headaches were cured by tDCS, don't the rest of you headache sufferers get your hopes up. 

Sources:  Anna Wexler's article "Zapping Their Brains At Home" appeared on the New York Times website on July 22 at http://www.nytimes.com/2016/07/24/opinion/sunday/zapping-their-brains-at-home.html.  I also referred to the open letter posted by Annals of Neurology at http://onlinelibrary.wiley.com/doi/10.1002/ana.24689/full and the Wikipedia articles on transcranial direct current stimulation and electroconvulsive therapy.  A recent report on one healthcare exchange in financial trouble is at http://www.foxnews.com/politics/2016/05/06/obamacare-exchange-problems-add-to-marketplace-woes.html.  You can read more about "The Snake Pit" at its IMDB site at www.imdb.com/title/tt0040806/.  

Watch Where You're Pokémon Go-ing

The Japanese megacorporation Nintendo was founded way back in 1889 to sell playing cards, and when I hear the word "Pokémon" I think of the collection of cards one of my nephews accumulated when he was about eight years old.  They showed bizarre-looking fantasy creatures that had complicated made-up genealogies and quirks that he committed to memory.  I figured Pokémon was one of those things that kids go through like a phase, and while it seemed important to him at the time, I couldn't imagine him, or anyone else, taking such things seriously as an adult.

Well, I was wrong, and not for the first time.  On July 6, Nintendo released a smart-app aspect of their Pokémon universe called Pokémon Go.  From what I can tell from Wikipedia and other sources, the idea is this.  You pick an avatar to represent you, and show up on a map of your vicinity, courtesy of the GPS function of your phone.  Then if you choose the augmented-reality mode, you can scan around certain special places shown on the map where the Pokémon critters typically hang out.  Spotting one, you can throw a (digital) Poké Ball at it, and if you hit it, you get points or go to bed happy or something good happens in the game, I'm not sure quite what.  There are good things and not so good things about this game, which has proved to be one of the instant hits of the smart-phone app world, allegedly being loaded onto 5% of all Android devices within two days of its release.

The nice thing I like about this game is that it encourages people to get off the couch and outside the house.  Nintendo is using the GPS database of another game company called Niantic, whose augmented-reality game Ingress did other things with the long list of physical sites that somebody had to compile manually.  There are apparently enough special spots in Pokémon Go to keep most players happy, at least in larger cities.  I'm not sure how many Pokémon Go enthusiasts live in Wyoming, for example, or Alaska.  But a number of national parks are included, as well as museums, city parks, lakes, and other publicly accessible sites, including the U. S. Holocaust Memorial Museum, which is reportedly not amused at the crowds of people with cellphones around their entrance shooting imaginary balls at imaginary beings. 

Anyway, that aspect of the game looks like an improvement over the usual zone-out-into-cyberspace effect that happens to millions of kids (and adults) when they play the usual type of electronic game. 

Now for the bad news.  Not everyone who plays Pokémon Go exercises good judgment in the old-fashioned real world that we all live in by default.  Maybe the most spectacular example of this problem came when two twenty-something guys near San Diego, California (one of whom might have been drinking) chased a Pokémon that appeared to be on the other side of a fence between them and the unstable edge of a cliff.  They climbed the fence anyway and fell off the cliff, landing 50 feet and 90 feet below.  Both survived, but with injuries.  Other reports include that of a girl who chased a Pokémon critter into busy traffic and got hit by a car, fortunately suffering only minor injuries, and numerous people walking into trees, driving into trees, or even driving into a police car while chasing a Pokémon in a parking lot.  Driving while chasing an augmented-reality Pokémon is bad judgment, but that apparently doesn't stop some people, until hitting something hard and unyielding in old-fashioned real reality does.

People have played games ever since there were people, and it's not for me to say how much time any individual should spend working versus burning calories and gasoline on chasing down fictional digital animals.  It's a little troubling that so many accidents have been reported in less than two weeks since the game's release.  Maybe it's just a startup glitch, and as those who haven't got the sense to put down their Pokémon Go games at appropriate times either wise up or possibly eliminate themselves from the gene pool, we will hear less about such accidents.  Something similar happened when the first smart phones came out, folks walking into swimming pools while watching the Weather Channel and so on, and we've somehow adapted to those hazards. 

I do expect that Nintendo is under a lot of pressure to make Pokémon beings show up at places that would like more people traffic, which is namely every retail business with walk-in outlets in the world.  So far, you mainly hunt the critters at parks, memorials, and other non-profit places.  If Nintendo caves to this temptation , you'll be finding Pokémon gyms at the nearest shopping mall, McDonald's, or Home Depot.  There would be nothing wrong with that, I suppose, as long as the game players know that certain Pokémon hangouts are "sponsored," I guess you'd call it.

What is of more concern is the accident aspect.  I'm not that coordinated, so I'm not sure what would happen if I was looking at a smart phone screen and trying to track some animated whatever-it-is and throw a digital ball at it.  The whole operation requires a kind of interaction with reality that is really a novel thing for most people, which is why it's so popular.  But it can be dangerous to the user and people nearby, too.  Maybe some fairly minor changes in the way the augmented-reality feature works will minimize the chance that you'll walk into a tree or a manhole or something while in hot pursuit of your extra ten points in the game. 

All in all, it seems like Nintendo has scored a hit with their latest variation on Pokémon.  If it gives millions an excuse to get outside among other people, that's a good thing, and if they can work out a way to minimize the occasional safety problems, that's even better.  While you won't be seeing yours truly watching a smart phone and following an imaginary critter around (first I'd have to buy a smart phone), I will understand what's going on if I see people glued to their phones while crowding around certain locales from now on.  But I'll also know to stay out of their way.

Sources:  I referred to the Wikipedia articles on Pokémon Go and Nintendo, and news reports from the following sources:  Slashgear.com at http://www.slashgear.com/five-pokemon-go-accidents-that-stress-the-importance-of-paying-attention-15448441/, USA Today at http://www.usatoday.com/story/news/nation/2016/07/14/pokmon-go-playercrashes-his-car-into-tree/87074762/, and NBC News San Diego at http://www.nbcsandiego.com/news/local/Two-Men-Fall-Down-Cliff-While-Playing-Pokemon-Go-386743551.html.

Cornfield Meet Near Panhandle, Texas: How?

On Tuesday morning, June 28, the stretch of U. S. 60 leading east from Amarillo, Texas past the small town of Panhandle was quiet in the early morning sun.  The flat horizon was broken only by the spinning blades of a wind farm in the distance and a towering grain elevator near the double BNSF tracks, which run straight as an arrow from Amarillo east-northeast for many miles.  U. S. 60 parallels the tracks until the road nears the grain elevator, where it takes a bend southward for a quarter mile or so around the elevator and rejoins the tracks on the other side.

           

At about 8:25 AM, a BNSF intermodal freight train was heading west on one of the pair of tracks.  At the same time, a few miles west of that train, another train was heading east—on the same track. 

Railroads have faced this kind of problem ever since there were railroads.  In England, the main customers of an early form of electric telegraph were railroads, who saw in it a way of coordinating train movements on single tracks carrying two-way traffic.  Later, block signals were developed that turned red any time a train entered a section of track (or "block"), warning other trains to slow down or stop.  The main idea of double tracks is to allow only one-way traffic on each track, eliminating any chance of head-on collisions.  And most recently, a new communications and control system called Positive Train Control (PTC) has been adopted by most U. S. railways, but its implementation has been slowed by problems with radio-channel allocations and hardware issues.  On June 28, PTC was not implemented in the section of tracks that run past the grain elevator near Panhandle.

So it was that the two trains that morning, each with a crew of two, met in a fiery head-on collision that is known in railroad circles as a "cornfield meet."  One person managed to jump from the train before the collision.  Two bodies were recovered after the accident, and as of July 10, the fourth person's body had not yet been found. 

A passerby on nearby U. S. 60 made a phone video of the wreck even as it was occurring.  You can see cars flying off the track, and eyewitnesses testified to the horrific noise that seemed to go on forever.  A train running at speed can take up to a mile to stop after the brakes are applied, and it is not clear at this point when, if at all, the brakes were applied on either train.  Many trains, including those involved in the wreck, are equipped with digital video cameras and recorders at the front and rear, but the National Traffic Safety Board spokesman in charge of the NTSB investigation said that some of these were heavily damaged.  However, other data recorders on board the trains may have survived to help understand how this accident happened.

It will probably be some months before the NTSB has time to sift through the wreckage and other evidence that could show why, in 2016, it's still possible to have such an accident.  As in other railroad accidents involving fatalities in the last few years, PTC could very well have prevented this one.  If operating properly, the system calculates a safe maximum speed for the train at each point in its travels, and if another train is heading for yours, presumably it would put on the brakes in time to prevent a wreck. 

Trains are dispatched these days by means of centralized train-traffic control centers linked to the individual trains by microwave radio.  One of the dispatch centers for trains in Texas is in Fort Worth, so investigators will probably be reviewing all communications between the controllers and the two trains involved.  Like air-traffic controllers, the dispatcher's word is law as far as the in-train operator is concerned.  So if both trains were told they had a clear track ahead, and saw something that looked like a train in the distance, each might have thought the other one was on the other track instead of the same track.  With radio control, it's not clear to me how much significance the operators attach to block signals, which should have indicated a problem in this case soon enough to prevent the accident.

As train wrecks go in the last few years, this accident was not the worst in terms of fatalities.  In this space in 2013 I wrote about a commuter-train wreck in New York that killed four, and in Philadelphia in 2015 another commuter train derailed, killing eight passengers and injuring over 200.  But the Panhandle wreck is disturbing because it seems to reveal a systemic problem, either with the dispatching system or training or both.  Those trains never should have been on the same track heading toward each other in the first place.  And once they were, it sure seems like block signals should have let the drivers know something was seriously amiss.  It is likely that this accident was the product of a combination of unlikely events, each one of which by itself does not typically lead to a major tragedy. 

But to know for sure, we'll have to wait for the results of the investigation.  And hope that BNSF and the other railways can speed up their implementation of PTC, which promises to make cornfield meets as rare in the future as deaths due to runaway horse-drawn buggies. 

Sources:  I used reports on the accident from KFDA-TV in Amarillo at http://www.newschannel10.com/story/32408347/search-ends-for-body-of-conductor-killed-in-train-wreck and a video of the NTSB news conference held after the wreck at https://www.youtube.com/watch?v=mCBTmxKx2vA.  A video of the wreck itself can be viewed at https://www.youtube.com/watch?v=YiPE8e-fqKU.  I blogged about PTC and train wrecks at http://engineeringethicsblog.blogspot.com/2013/12/positive-train-control-and-commuter.html on Dec. 9, 2013 and at http://engineeringethicsblog.blogspot.com/2015/05/for-want-of-spectrum-allocation.html on May 25, 2015. 

Self-Driving Car Fatality No. 1: Joshua Brown Makes History

On May 7 of this year, Joshua Brown, owner of a wireless-network technology company and Tesla car enthusiast, was riding in his Tesla Model S on a divided highway in Florida.  Mr. Brown loved his car and posted numerous YouTube videos that showed him using the autopilot function in the "look, Ma, no hands!" mode.  By all accounts, Brown was a generous, enthusiastic risk-taker (his specialty when he was in the military was disarming weapons, according to a New York Times report), and hands-free driving went against the explicit instructions Tesla provides for the autopilot feature.  But Tesla owners do it all the time, apparently, and until May 7, Mr. Brown had gotten away with it.

Then a tractor-trailer rig made a left turn in front of Mr. Brown's Tesla.  According to a statement by Tesla, the high ground clearance of the trailer and its light color, resulting in low visual contrast against the sky, failed to trigger the car's brakes.  The Tesla ran underneath the trailer, fatally injuring Mr. Brown.  A neighbor quoted Mr. Brown afterwards as saying in another context a few weeks before the accident, "For something to catch Elon Musk’s eye, I can die and go to heaven now."  No one knows how serious Mr. Brown was when he said that.  But he will go down in history as the first person in the U. S., and perhaps in the world, to die in a car that was operating in its self-driving mode.

Will this tragedy spell doom for self-driving cars?  Almost certainly not.  The first recorded steam-locomotive railway fatality was that of the English politician William Huskisson, who attended the opening ceremonies of the Liverpool and Manchester Railway on Sept. 15, 1830, which featured inventor George Stephenson's locomotive the Rocket.  Wanting to shake the hand of his former political enemy the Duke of Wellington, Huskisson walked over to the Duke's railway carriage, then saw that the Rocket was bearing down on him on a parallel track.  He panicked, tried to climb onto the carriage, and fell back onto the track, where the locomotive ran over his leg and caused injuries that were ultimately fatal.  Passengers had been warned to stay inside the train, but many paid no attention. 

If Huskisson's death had been mysterious and incomprehensible, it might have led to a wider fear of railways in general.  But everyone who learned of it took away the useful lesson that hanging around in front of oncoming steam locomotives wasn't a good idea, and railways became an essential feature of modern life.  Nevertheless, every accident can teach engineers and the rest of us useful lessons in how to prevent the next one, and the same is true in Mr. Brown's sad case.

It's not clear how long the Version 7.0 of the Model S software featuring the autopilot function has been available, but it's probably been out for at least a year.  Multiply that time by the number of Model S owners and how far they drive, and you have a track record that shows if anything much is wrong with the software, it's not very wrong.  Model S owners aren't dying like flies in autopilot accidents.  Still, telling drivers how great a self-driving feature is, and then expecting them to pay constant attention as though the car were a driver's ed student and you were the instructor, is sending a mixed message.

Tesla's own posting about the accident cites statistics that show if anything, Model S cars have a lower accident rate than average, and that may be true.  But as Tesla's public profile rises, the firm has some delicate maneuvering ahead of it to avoid becoming a target for lawyers who will want to portray Tesla in court as heedless of driver safety.

We've known since the earliest days of automobiles that they are dangerous in careless hands and require constant vigilance on the part of the operator.  Plenty of people ignore that fact and pay for it with injuries or their lives, and take the lives of others as well.  But everybody, whether safe or careless, still admits it's a good idea to pay attention while you're driving.

Now, however, something fundamentally new has been added.  When a car has a self-driving feature that nevertheless requires you to be ready to take command at a moment's notice, the driver is torn between letting the machine take over and keeping a constant lookout for trouble.  You can't both be constantly vigilant and also watch a Harry Potter movie, as Mr. Brown may have been doing at the time of the accident.  In most of us, especially guys, attention is a focused thing that has to be directed at one primary target at a time.   Even if I had a self-driving car (which I don't), and after driving it for a while and learning what it typically can and can't do, I wouldn't feel very comfortable just sitting there and waiting for something awful to happen, and then having to spring into action once I decided that the car wasn't doing the right thing.  That's a big change of operating modes to ask a person to do, especially if you've been lulled into a total trust of the software by many miles of watching it perform well.  Who wouldn't be tempted to watch a movie, or read the paper, or even sleep?

I'm afraid we've got some institutionalized hypocrisy here that most auto companies are fortunately free of.  But Tesla is a different kind of beast, founded at a time when anybody who ever installs software is either forced to lie, or actually has to read dozens of pages of legal gobbledegook before clicking the "I Agree" button.  The impression I have of the arrangement between Tesla and Model S owners is that Tesla pretends that  they have to keep their hands on the wheel, and the owners pretend that they're following instructions.  And the pretense has made the lawyers happy, I suppose—until now.

Now that the much-anticipated First Fatality has happened, things could go in any of several directions.  The National Highway Transportation Safety Administration, which is investigating the accident, could come out with a bunch of heavy-handed federal regulations that could squash or set back autonomous vehicles in the U. S. for many years.  Joshua Brown's relatives could mount a lawsuit that could cripple Tesla.  Or (and this is the one I'm hoping for), Tesla's engineers can learn what went wrong in Mr. Brown's case, fix it, and deliver clearer, more practical instructions to drivers, including some human-factors engineering that seems to be missing, about how to use the self-driving feature, so that the remaining Tesla drivers can lessen their chances of becoming Fatality No. 2.

Sources:  Many news outlets carried reports of Mr. Brown's death.  Tesla's own posting concerning the incident appeared June 30 at https://www.teslamotors.com/blog/tragic-loss.  I referred to reports on Fortune's online version at http://fortune.com/2016/07/02/fatal-tesla-crash-blind-spot/, the New York Times report on Mr. Brown's background at http://www.nytimes.com/2016/07/02/business/joshua-brown-technology-enthusiast-tested-the-limits-of-his-tesla.html, the Tesla press kit on its autopilot at https://www.teslamotors.com/presskit/autopilot, and the Wikipedia article on William Hoskisson.  Thanks to my wife for notifying me about the incident.